'Colic' case study

I first meet Zoe when she was pregnant and I was visiting her sister for a consultation with her baby Pepin. Zoe only had a week until her due date at the time and was sitting in on the consultation to learn a little more for her baby. 

 

Fast forward four weeks, and I got the pleasure of holding her baby, Frankie, at age three weeks when Zoe and Adrian (Dad) popped into my home to pick up a BabyCues book for one of her friends. Frankie was due a feed while with us, so I watched her latch, which she did very well, but I noticed during the feed that she continued a suck swallow ratio of ‘one suck : one swallow’ throughout the entire feed. This little girls was super-efficient at extracting milk. Mum confirmed this, telling me she had gained 440grams in seven days. Over twice the recommended amount by the World Health Organisation. On asking whether Frankie was settled, Dad replied she was starting to get upset at night - the so called ‘witching hour’ from the cause of overloading was starting to show itself, as it often does at three weeks of age...

It is common for newborns to generally feed and sleep well in the first week to two weeks of life as they adjust and rest up from the birth, even if they have are feeling Digestive Overload. Then, around three weeks of age, when they begin to wake up to the world and what they are feeling in their bodies a little more, they start to become vocal about any Digestive Overload that is occurring. Whether this is from:

Given the weight gain and Frankie’s suck/swallow ratio, she was certainly feeling Digestive Overload from feeding for too long at the breast and too often – at this stage she was feeding around every 3 hours and anywhere from 10-45 minutes on the breast. Also, because of the discomfort of the overload of food, she wasn’t feeling relaxed enough to release her trapped wind, which was compounding her discomfort.

Checking Frankie's tongue and lip for a tie was a pleasure. She had the best tongue I had seen in a while – meaning no tongue tie in-sight, which is a rarity in my work these days. In fact I think I said to Zoe at least four times, something along the lines of, “Wow – look at her tongue. Beautiful!” Her lip was fine to.

On asking about Frankie's bowel motions, Zoe relayed that she had a dirty nappy after each feed. This is indicative of her food travelling through her system too quickly from the volume she was receiving. For a three week old we like to see around one good bowel motion a day with perhaps two smaller ones. Some baby's that have Digestive Overload go to the other extreme, experiencing constipated from the sheer volume they are receiving. This happens because of the tension from discomfort has then holding onto their stool longer. Of course we must also be aware that reduced bowel motions can mean hunger. If you are unsure which of these is happening for your baby, please feel free to book in for a consultation.

Advised changes

So, in order to stop Frankie falling into the awful cycle that is often promoted to parents as ‘normal’ – namely the witching hour – I advised Zoe to reduce Frankie’s time at the breast to 10-15 minutes to start with, and to continue as they were with only feeding one side for each feed.

At the time of their visit Frankie’s stomach was distended with an overload of wind. This is sadly a common scenario for our young – bloated stomachs. I advised Zoe that until Frankie felt better from being fed less, burps will continue to be a bit elusive and hard to release. Then, as Frankie felt more comfortable she would feel relaxed enough to release her burps easier. I also reassured her that it takes time to learn how to burp a baby for the first time, that practice builds confidence. Frankie was also still at an age where she was learning its okay to release burps. All of this tends to get easier around four to five weeks, and then again at three months. By six months an infant can cope with more trapped air travelling through the intestines. Thus burping becomes less of a priority but is still a necessity at times.

We also re-evaluated Zoe’s breastfeeding diet. She was still consuming a little dairy so I advised she stopped this because as humans we struggle to breakdown the proteins in dairy, casein and whey, for the first year of life. Taking it out of a breastfeeding diet can make a remarkable difference.

Over the next few days these are some of the messages I received from Zoe as they progressed through the changes and I continued to advise where necessary...